Handwriting Change as a Psychiatric Symptom

Abstract

Graphology is the study and analysis of handwriting especially in relation to human psychology. Many neurological disorders like apraxia and chorea can affect handwriting. Many psychiatric disorders like Depression, Obsessive Compulsive Disorder, schizophrenia are also linked with handwriting change. A unique presentation of major depressive disorder manifesting as chief complain of handwriting change was observed in a girl who had nice handwriting before depression. In spite of constant efforts she was not able to revert back to her original handwriting. Her new handwritings were different from old one in form of width and height of letters, organization and overall presentation. She was prescribed antidepressants. Depressive symptoms were relieved and her handwriting started gradually improving considerably though previous level had not been achieved.
Analysis of handwriting as a tool to understand the emotional state of person can be implicated during psychiatric assessment. The written off science of graphology needs to be made specific and sensitive so that it could provide more accurate results. Further research in this area is warranted.</p

Full text

Mehta et al: Handwriting change as a psychiatric symptom DOI:10.19056/ijmdsjssmes/2016/v5i1/83579
IJMDS ● www.ijmds.org ● January 2016; 5(1) 1075
Case Report
Handwriting change as a psychiatric symptom
Singh GH1, Mehta RJ2, Shah ND3, Mehta RY4
ABSTRACT
Graphology is the study and analysis of handwriting especially in relation to
human psychology. Many neurological disorders like apraxia and chorea can
affect handwriting. Many psychiatric disorders like Depression, Obsessive
Compulsive Disorder, schizophrenia are also linked with handwriting change.
A unique presentation of major depressive disorder manifesting as chief
complain of handwriting change was observed in a girl who had nice
handwriting before depression. In spite of constant efforts she was not able to
revert back to her original handwriting. Her new handwritings were different
from old one in form of width and height of letters, organization and overall
presentation. She was prescribed antidepressants. Depressive symptoms were
relieved and her handwriting started gradually improving considerably
though previous level had not been achieved.
Analysis of handwriting as a tool to understand the emotional state
of person can be implicated during psychiatric assessment. The written off
science of graphology needs to be made specific and sensitive so that it could
provide more accurate results. Further research in this area is warranted.
Key words: Apaxia, antidepressants, chorea, graphology
Introduction
Since long, handwriting has been used to
identify personalities and emotional states
(Graphology) in people. [1] In the act of writing,
we make many spontaneous movements. These
movements are recorded on paper and reflect
our ever-changing emotions. This recorded
movement - handwriting - is like an open
window through which we can observe the
whole vista of a personality. Handwriting like
speech is directly connected with our thought
process. It is also particularly responsive to
emotions such as sadness or enthusiasm.
During the process of writing, we transfer our
feelings onto paper and the words that we have
shaped reflect these emotions. In fact,
handwriting is so amazingly sensitive that it can
be something of an emotional barometer.
Excitement, fear, anxiety, irritability or anger
can be seen quite clearly. [2,5] That is why an
understanding of handwriting can be so
valuable; for example if you write while you are
feeling nervous, feeling of anxiety will show up
as an almost imperceptible trembling in the
strokes of certain letters. It may not be
immediately visible at a quick glance (although
sometimes it is) but it will in all likelihood show
up under a microscope. This is because your
handwriting is the written externalization of the
vibrant activity going on inside you. It is a type
of mental photograph of your inner processes
where small quick movements reflect the inner
vibration of activity within and round smooth
movements show your feeling of relaxation and
calm. [3] This is but one aspect; there is so much
to handwriting analysis.
Graphology is the study and analysis of
handwriting especially in relation to human
psychology. In the medical field, it can be used
to refer to the study of handwriting as an aid in
diagnosis and tracking of diseases of the brain
and nervous system.[1] Every literate human has
1
Dr Gaurav Harvir si ngh
MD, Psychiatry
Post Doctoral Fellow at Community
Psychiatry
NIMHANS, Bangalore
wardhapharma@yahoo.com
2Dr Mehta Radha Jaiprakash
Assistant Professor, Psychiatry
Hospital for Mental Health
Ahmedabad, Gujarat
3Dr Shah Nilima Deepak
Assistant Professor, Psychiatry
BJ Medical College, Ahmedabad
itisnilima@gmail .com
4Dr Mehta Ritambhara Yashwant
Professor & Head, Psychiatry
Government Medical College
Surat, Gujarat
ritambharam@yahoo.com
Received: 17-08-2015
Revised: 20-09-2015
Accepted: 02-10-2015
Correspondence to:
Dr Radha Mehta
radhe211@yahoo.co.i n

Mehta et al: Handwriting change as a psychiatric symptom DOI:10.19056/ijmdsjssmes/2016/v5i1/83579
IJMDS ● www.ijmds.org ● January 2016; 5(1) 1076
his or her own manner of writing. There are
many peculiarities in a handwritten text’s
specific shape of letters, e.g. their roundness or
sharpness; regular or irregular spacing between
letters; the slope of the letters; the rhythmic
repetition of the elements or arrhythmia; the
pressure to the paper; the average size of
letters etc. [3] there is a long list of neurological
disorders that affect handwriting, some of
them are Congenital apraxia, Strephosymbolia,
Cerebral hemorrhage/ trauma, Encephalitis,
Paralysis agitans, Toxemia/ alcohol,
Huntington's chorea and many more. [7.8.9,10] In
various studies many psychiatric disorders are
also linked with handwriting change like
Depression, Obsessive Compulsive Disorder,
schizophrenia and other types of psychosis.
[6,11,12,13, 14]
Case Report
Patient Miss N, a third year MBBS student
presented to psychiatry department with
complains of change in her handwriting since 1
year and in spite of constant efforts she was not
able to revert back to her original handwriting,
the change in handwriting took place in a
period of 2 months gradually. Patient became
increasingly worried as her grades began to fall
due to poor handwriting. Patient consulted 2
different neuro physicians without any
improvement; underwent MRI spinal cord and
MRI brain (including functional MRI), muscle
charting & nerve conduction study of right
hand (suspected as thoracic outlet syndrome
and as a diagnostic scan) which were normal.
Patient’s new handwriting (Fig.3) differed from
old (Fig.1) in following ways:
 85% increase in width of letters
 10% increase in height of letters
 Baseline not followed as before, words
were frequently above and below the
baseline
 Previously used to write 5 to 6 words in a
line but now writes only 3 – 4 words in a
line
 Decreased consistency, irregular slanting,
decreased organization, decreased
connectivity of letters in words with
increased angulations.
Fluency, speed and pressure on paper were
more or less same.
On detailed interview patient revealed
that since 1 year she had conflict in form of
breaking up 5 years old love relationship with
her boyfriend mutually as he belonged to other
religion and they were afraid that their families
would not approve of their marriage. Since
then patient had complains of:
 decreased participation in previously
pleasurable activities like participating in
extracurricular activities, travelling and
reading
 persistent sadness of mood
 disturbed sleep and appetite
 preoccupation with thoughts regarding the
event
 crying spells
 mild anxiety off and on
For further exploration of effect of stressor on
handwriting patient was made to write on
paper while imagining on different situations;
and her handwriting evaluated and results were
interesting. On writing a letter to her boyfriend
to whom she was intensely emotionally
attached the new handwriting (Fig.2)
characteristics became much more prominent
like: (as compared to original handwriting
(Fig.1)
 A 150% increase in width of letters
 15% increase in height
 Increased deviance from baseline
 Only 2-3 words in a line
 Decreased connectedness of words
 Markedly decreased organization and
consistency
On writing a letter to her brother to
whom she was moderately emotionally
attached the handwriting change became less
prominent as was in case of letter to boyfriend
but on artificially creating a mental situation in
which patient continued her letter imagining
that she was telling her brother that she had
married against their parent’s will the

Mehta et al: Handwriting change as a psychiatric symptom DOI:10.19056/ijmdsjssmes/2016/v5i1/83579
IJMDS ● www.ijmds.org ● January 2016; 5(1) 1077
disturbance in handwriting again became
prominent.
On writing a letter to her teacher to
whom she had no emotional attachment the
newly acquired handwriting (Fig. 2) did not
show any further change. Premorbid
personality analysis of patient revealed that she
was introvert in nature, never used to express
anger on others even in extreme conditions,
was particularly good in studies, quoted
frequently as an ideal example in her family and
her cherished childhood memories were
focused mainly on academic achievements.
There was no history of psychiatric illness in her
or in family.
Patient was prescribed antidepressant
for her depressed mood. In the course of
events after starting antidepressant patient
again reconciled with her boyfriend and couple
became committed again. Depressive
symptoms were relieved following 1 month of
antidepressant treatment. At one month follow
up patient’s handwriting had gradually
improved (Fig. 4) but still did not attain
previous level though there were no further
episodes of worsening of handwriting. Mental
status examination was not significant for any
psychopathology. Patient took antidepressants
for 6 months and did not show any further
signs of depression. At six month follow up
handwritings were considerably improved
though still previous level had not been
achieved.
Fig.1 Before illness
Fig.2 During illness
Fig. 3 During illness
Fig. 4 After treatment
Discussion
Above patient’s condition can be discussed
under following aspects: A unique presentation
of major depressive disorder manifesting as a
primary complain of handwriting change. In
general due to lack of awareness regarding
depressive episode, attribution of it to
environmental stressors and masking of
symptoms due to good social support patient
may present with such complains. Also
prominent studies in past as well as present
times have documented handwriting change in
patient’s of depressive illnesses [4,13,14] linking it
to basal ganglia dysfunction and or and/or
deficient activity of the sensory motor cortex
and the supplementary motor area. [13]
Stressor/conflict in psyche manifesting
itself as neurological sign in form of
handwriting change warranting diagnosis of
conversion disorder which is supported by the
fact that changes become more prominent as
the stressor is aggravated. In educated people
(specially with medical background)
presentation of conversion symptoms is less
likely to be possession episodes, episodes of
unexplainable unconsciousness or
breathlessness etc, their inner conflict can seek
attention by means of such symptom as
handwriting change.

Mehta et al: Handwriting change as a psychiatric symptom DOI:10.19056/ijmdsjssmes/2016/v5i1/83579
IJMDS ● www.ijmds.org ● January 2016; 5(1) 1078
Analysis of handwriting as a tool to
understand the emotional state of person can
be implicated during psychiatric assessment.
The written off science of graphology needs to
be understood better and made more specific
and sensitive so that it could provide more
accurate results. Further research in this area is
warranted.
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Cite this article as:
Singh GH, Mehta RJ, Shah
ND, Mehta RY. Handwriting change as a
psychiatric symptom. Int J Med and Dent Sci
2016; 5(1):1075-1078.
Source of Support: Nil
Conflict of Interest: No